November 2005 | Vol. 23, No. 11

Congress Considering Several Important Health Care Bills

According to Sidley Austin Brown & Wood LLP, SVU’s regulatory and legislative advocacy firm, as part of the annual federal budget process Congress is working through spending legislation that includes a number of provisions critical to health care providers. Both the House and Senate were reviewing health care bills at the end of October. Two of the most notable provisions include language to avoid Medicare payment cuts for professionals paid pursuant to the physician fee schedule and pay-for-performance (P4P) measures designed to improve health care quality. The Senate legislation would replace the anticipated fee schedule cut with a one percent increase in payments beginning on January 1, 2006.

With regard to P4P, beginning in 2007, physicians and providers who do not submit the required quality data would receive an update to the conversion factor minus two percentage points. To qualify for full payment, physicians and practitioners would be required to submit appropriate data necessary for a value-based purchasing system in the specified form, manner, and time of the data submission as determined by the Secretary of Health and Human Services.

The Senate is contemplating a phased-in approach to the public reporting of data for physicians and practitioners. In the first phase, public reporting would identify physicians and practitioners who had reported data, without any information on what the data revealed. In the next phase, public reporting would identify those physicians and practitioners who had been awarded value-based payments for high quality, efficient care and improvement. For the last phase, public reporting would reveal the actual data being reported by physicians and practitioners on the quality measures. Procedures, established by the Secretary, would be required to provide the physicians and practitioners with an opportunity to review the data before it is released to the public. The HHS Secretary would be allowed to make exceptions to the requirement for making data available to the public by taking into account the size and specialty representation of the practice involved when providing such exceptions.

Many provider groups are troubled by this plan because it would negatively impact those who are unwilling to participate. To fund the value-based purchasing program for physicians and practitioners, the conversion factor would be reduced as follows: 1.0% in 2009, 1.25% in 2010, 1.5% in 2011, 1.75% in 2012, and 2.0% in 2013 and subsequent years.

Remember to check e-Spectrum each month for the status of this legislation and similar proposals as they progress through the House and Senate